An average schoolchild requires 1,600 to 1,850kcal of energy per day. Let's say he eats three grilled pork skewers and a doughnut for breakfast, a pad Thai and a piece of chocolate cake for lunch before wrapping up his day with fried rice and a piece of Hawaiian pizza. All this is almost 2,400kcal. If this boy is a couch potato, he could soon turn himself into one fat kid.

The imbalance between energy intake and energy expenditure is among the reasons why Thai kids are getting fatter and fatter today where weight issues and obesity among children are considered two of the country's biggest healthcare conundrums. A report recently released suggested obesity is rife among kids and left unattended could potentially cause Thailand to miss its target of improving nutrition and achieving food security by 2030.

The study, called Multiple Indicator Cluster Surveys or MICS and conducted by the National Statistical Office together with Unicef, allows researchers to compare data collected from 2006, 2012 and 2016. According to MICS, the percentage of children aged below five who are overweight rose from 6.9% in 2006 to 11% in 2012. In 2015, the situation was slightly better where 8.2% of children under five were reported to be overweight. It is important, nonetheless, to note that MICS collected and analysed data based on the World Health Organisation's (WHO) growth standard.

Assoc Prof Dr Ladda Mo-suwan of the Faculty of Paediatric Nutrition, the Department of Paediatrics at Songkla University, raised her concerns when it comes to overweight and obesity among Thai children. She cited the National Health Examination Survey, which has been conducted five times by the Health Systems Research Institute under the Ministry of Public Health. Based on Thailand's growth reference, the latest report, which collected data from 2014-2015, saw 11.4% of kids aged one to five being classed as overweight -- a sharp rise when compared from only 5.8% in 1995. For schoolchildren, the percentage of overweight kids jumped to 14% -- more than twofold when compared to 1995.

"Schoolchildren are found to be more overweight than smaller kids because those in school can buy food for themselves. They can be more stubborn," said Dr Ladda, who is also part of the National Health Examination Survey.
On a global scale, the situation is disturbing. According to data from the WHO, around 41 million children under the age of five were overweight or obese in 2016. Over 340 million children and adolescents aged five to 19 were overweight or obese in 2016. Worse, nearly half of the children under five who were overweight or obese in 2016 lived in Asia.

Two significant contributing factors for obesity among Thai kids, commented Dr Ladda, are food intake and lack of physical activity. Food, snacks and sugary drinks -- which are high in calories, fat and sugar -- are more available and easily accessible these days. Fuelled by a lack of exercise and physical activeness, the issue can speed from bad to worse.

"Being overweight is mainly a consequence of overeating and underexercise," said the researcher.

"Modern kids have more sedentary activities. Phones and tablets steal more of their time that could otherwise be spent on physical activities. This kind of situation is happening not just among city kids but also those in rural areas."

Setting aside unbalanced lifestyles and eating habits, paediatrician Dr Piyarat Lertbunnaphong cited three other factors that can potentially cause child obesity, though less likely. "A number of [medical] papers both in Thailand and other countries have addressed child obesity. Even in Thailand's rural areas where food is not as abundant as in cities, children are found to face less under-nutrition but are reported to be more obese. What's also responsible for child obesity, besides improper lifestyles, are genetics, hormone-related abnormalities and steroids," explained the paediatric endocrinologist.

Echoing Dr Ladda's viewpoint, Dr Piyarat said increasing food availability and accessibility is a big part of this picture.
"Food today is very rich in fat and sugar. Food has become so rich in flavour, full of fat and butter but low in fibre. Children can easily buy bottled sweet drinks from convenient stores which are very high in sugar. They eat this kind of food and they live their convenient life, walking less for example because of better transportation. They only sit and spend time on their phones. Basically, they eat more but exercise less."

One indicator, said Dr Ladda, to foresee a child's chance of becoming obese or suffering eating-related diseases like diabetes is his or her first 1,000 days.

"Diets and exercise are things you have to pay attention to throughout your life. But the first 1,000 days can serve as a prediction for a kid's future health to a certain extent."

Being overweight doesn't just affect a child's appearance. It could be followed by other chronic diseases, including diabetes, kidney and liver diseases, heart diseases, high blood pressure, diabetes, snoring, sleep apnoea, knee deterioration and leg distortion. "Being fat can also affect them psychologically," added Dr Piyarat. "They might be bullied, lose confidence and have chances of suffering depression."

Parents' fears that their kids may become obese usually grows at a very sluggish pace -- often too slow.
Many Thai parents and grandparents believe that fat kids are adorable and that they will automatically turn slimmer when they grow up and get taller. This, unfortunately, is a myth.

"Sometimes it takes too long for parents to realise that their child is overweight because they like fat kids. They only realise there is a problem when a child is very, very fat. Denial is prevalent among Thai families. And when it takes too long to realise there is a problem, it takes longer to fix it," said the endocrinologist.

The food industry and manufacturers play a hugely significant role in the child obesity saga.
"They compete with each other in delivering to the market food that is detrimental to health," said Dr Ladda. "Advertising and marketing is conducted directly with kids, making them want to eat."

Admittedly, curing this national healthcare headache is a daunting task which requires collaboration from all parties to get things on the right track.

The food industry, of course, should be aware of the consequences should they keep creating unhealthy products and feeding them to the country's young generation.

Schools, where children spend most of their time, should help with preventive measures such as providing a nutritionally balanced lunch or arranging more exercise sessions, suggested Dr Piyarat. But above all, parents and senior family members are the most powerful variables in a child's health.

"To fix child obesity, we must fix parents' attitudes," said Dr Piyarat. "They must understand that fat kids are not adorable and that fat kids are not always healthy kids. Parents must have the knowledge of what they should and should not eat. Here medical practitioners at hospitals can come into play, providing guidelines and nutritional data so parents know what they can do at home."

"Parents should be especially vigilant with schoolkids because they can start finding and buying food themselves. Tell them the only two things they are allowed to buy from a convenience store beverage cooler are water and plain milk," Dr Piyarat added.

"Parents must be aware that good physical health is a stepping stone for brain health," concluded Dr Ladda. "They must stop thinking that child obesity will cure itself when a child grows up."

May you be in heaven half an hour before the devil know`s you`re dead!

I cycled by the HH High School gates at kicking-out time last week..it was unbelievable the percentage of fat chunky girls..I'm talking double the size they should be..& all sat enjoying sausages, etc...it really was an eye-opener!
(And I'm really not talking about 1 or 2 hefty lumps..as I passed I counted 20+..!)